The National Library of Medicine

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The National Library of MedicinesNative America
Outreach PortfolioOverview and Lessons Learned

• by Fred B. Wood, Gale Dutcher, Angela Ruffin,
  Paul Theerman, and Patricia Tuohy, NLM
• Conference of Native American
• Health Information Services
• Albuquerque, NM July 20-21, 2006

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Outline

• OverviewFred Wood
• Sacred RootGale Dutcher
• NN/LM Lessons LearnedAngela Ruffin
• MHA SystemsPaul Theerman
• Native Healing ExhibitPatricia Tuohy

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Native Outreach PortfolioThumbnail Sketch

• by Fred Wood, OHIPD/NLM
• Tribal Connections NN/LM, OHIPD
• I (Pacific Northwest) PN RML
• II (Pacific Southwest) PN RML
• III (3 Northwest sites) PN RML
• IV (Four Corners NM, AZ, UT, CO)
• 3 RMLs, 4 RLs

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Native Portfolio, Contd

• Sacred Root Native Internship Project, SIS
• Tribal College Outreach and Librarianship
  Projects, NN/LM SIS
• Tribal Community Outreach Projects, NN/LM
• Tribal Powwow Participation, NLM NN/LM

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Native Portfolio, Contd

• Intertribal Collaboration, e.g., NCAI Health
  Information Task Force, SIS
• Listening Circle Project, NLM, OHIPD
• Health Information Web Sites
• -- Tribal Connections, PN RML
• -- Native American Health on MedlinePlus, LO/PSD
• -- Arctic Health, SIS
• -- American Indian Health, SIS

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Native Portfolio, Contd

• Native Hawaiian Community Project, Milolii and
  Waimanelo, OHIPD
• Native Hawaiian Healing Materials Project, OHIPD
• Tribal Economic Development Project, MHA Nation,
  OHIPD, HMD, SIS
• Native Health Healing Exhibit, HMD

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Underlying Outreach Strategies

• Improving information infrastructure and
  technical capabilities
• Employing communication methods that are
  culturally sensitive and appropriateNative
  consultation is key
• Building effective partnerships with Native
  community groups and national organizations

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Strategies, Contd

• Training Native health and information
  professionals, and community leaders and members
• Increasing the scope of NLMs information
  products and services to cover more
  Native-related material
• Emphasizing capacity building in Native
  communities where possible

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Strategies, Contd

• Making site visits to assure direct interactions,
  full understanding, and effective working
  relationships
• Fine tuning outreach planning and evaluation for
  Native community-based projects
• For more info, see JMLA Vol. 93, No. 4,
  Supplement on Community-Based Health Information
  Outreach

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Some Native Inspiration

• All my relatives (family, friends, peoples, and
  intelligences)
• Let every day be a good day
• Live in harmony with the Medicine Wheel and
  Sacred Tree
• With the wisdom, foresight, and strength of the
  Eagle
• For the good of the Next Seven Generations

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Sacred Root

• Native American Information Fellowship
• by Gale Dutcher, Head,
• Outreach Special
• Populations, SIS/NLM

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Purpose of Fellowship Program

• Develop capacity of native communities
• Improve access to health information
• Develop relationships

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How it Works

• Two year program
• Two participants from each group
• Mid-career professionals
• Health and/or technology backgrounds
• Funding
• Stipend
• Travel
• Training
• Laptop computer
• Local project

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Activities

• Initial two weeks at NLM
• Online training classes
• Orientation to NLM
• Focused meetings with staff
• Training/Conferences
• Dependent upon specific needs/interests
• Connection with RML and NN/LM
• Additional activities possible

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Project Development

• Culminating activity
• Proposal writing
• Funding provided by NLM

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Origins of Fellowship Program

• Co-funding by the NCMHD end of 2001
• Meeting with Tex Hall, Chairman, MHA Nation
• Creation by NCAI of Presidents Task Force on
  Health Information

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Current Status

• 2002 Interns from MHA Nation - Richard Mayer
  and Deborah Thompson
• Internship completed
• Project implemented
• Training relationship Univ. North Dakota HSL
• Project Expansion
• Ongoing NLM-MHA activities

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Status, continued

• 2003 Nez Perce Tribe Tina Bullock and Jim Pond
• Year one completed 2004
• Project underway

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Nez Perce Project

• Tablet PCs and Hand-held devices for clinicians
• Access health information with patients

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2004

• Native Hawaiian Fellows
• Papa Ola Lokahi
• LorrieAnn Santos and Momi Fernandez

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Hawaiian Projects

• Support for Cancer project
• Development of game
• Promotional materials
• Develop GIS capacity
• Training
• Implementation of Health Equity Review
• Data users group

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Plans

• Continue to work with NCAI Task Force
• Next group will start in the fall
• Evaluation of program
• Continue to build upon these relationships

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Reflections on NN/LM Outreach

• By Angela Ruffin, Head, NNO/NLM
• Outreach to Minority, Underserved and Native
  Communities
• Lessons learned through the years
• Enhanced lessons learned
• 2006 2011 Priorities

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Earlier Lessons Learned -Pre Web Access

• Time to plan and implement project
• Identify information needs of target population
• Identify onsite contact person
• Tailor training to audience

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Earlier Lessons Learned Electronic
AccessOutreach

• Getting out
• Cultural competence
• Training
• - Demonstration/Training
• Training content
• Customize
• Hands-on
• Basic computer skills
• Train the trainer
• Location of training (onsite/offsite)
• Follow-up training

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Earlier Lessons LearnedElectronic AccessProject
Administration

• Planning
• Delays
• Staffing
• Flexibility

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Earlier Lessons LearnedElectronic
AccessAssessing Information Needs

• Not a one-time exercise
• Needs vary by group and readiness

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Earlier Lessons LearnedElectronic
AccessObjectives and Outcomes

• Objectives follow from assessing needs
• Identify key players/community leaders at site
• Continued presence communication
• Stay poised to alter course
• Outcomes
• Raise awareness
• Increase access
• Affect use effectiveness
• Change in information seeking

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Earlier Lessons LearnedElectronic
AccessCollaborations

• Leadership/Key on-site contacts
• Diverse expertise
• Commitment
• Communication
• Sustainability

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Earlier Lessons LearnedElectronic
AccessPartnerships

• Require common needs, mutual goals, mutual
  respect, shared resources
• Communication

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Enhanced Lessons LearnedCommunity Based Outreach

• Understand the community
• - Language
• - Culture, beliefs, traditions
• - What they think worry about
• - Information needs uses
• - What/who are their communication channels
• - What/where are their cultural and
  friendship centers
• Meet them on their turf and where they are
• - Telecommunication infrastructure
• - Information skills

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Enhanced Lessons LearnedCommunity Based Outreach

• Participatory planning
• Asset-based versus solely needs-based approach
• Relationship building
• Creativity
• More community engagement
• Community partners as empowerment

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2006-2011 RMLs and Centers
University of Illinois, Chicago
University of Washington
University of Massachusetts
University of Utah
University of California, Los Angeles
New York University
University of Maryland, Baltimore
Houston Academy of Medicine Texas Medical Center

• National Training Center and Clearinghouse (NTCC)
  New York Academy of Medicine
• Outreach Evaluation Resource Center (OERC)
  University of Washington
• Web Services, Technology Operations Center
  (Web-STOC) University of Washington

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Priorities for 2006-2011

• Outreach
• Community partnerships, CBOs
• Regional evaluation experts
• Dissemination of best practices
• Encourage/identify cross regional opportunities
• Proposal writing assistance
• Health information literacy
• Expanded scope of technology conferences

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Instruction, consultation, and planning support
based on Measuring the Difference Guide to
Planning and Evaluating Health Information
Outreach, plus three new booklets to update the
Guide!
http//nnlm.gov/evaluation/
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NN/LM Funding Mechanisms

• Major outreach/consumer health projects
• Express outreach awards
• Outreach Planning awards
• Outreach Follow-up awards
• Partnership planning awards
• Technology improvement/Internet connections
  awards
• Training awards
• Technology awareness conferences
• Exhibit awards

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MHA Systems and NLMs History of Medicine
Division

• Collaboration in Library Work
• A Learning Process
• by Paul Theerman
• Head, Images and Archives
• History of Medicine Division
• National Library of Medicine

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MHA Systems and NLMs History of Medicine
Division

• MHA Systems
• A tribal business of the Mandan-Hidatsa-Arikira
  Nation, the Three Affiliated Tribes of Fort
  Berthold Reservation, New Town, North Dakota

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MHA Systems and NLMs History of Medicine
Division

• Background
• Listening Circle established through NLMs Office
  of Health Information Programs Development
  (OHIPD), Elliott Siegel, Director, and Fred Wood
  as principals
• NLMs Director, Dr. Donald A. B. Lindberg, met
  with Mr. Tex Hall, Chairman of MHA Nation, to
  begin a project to build tribal IT capacity and
  to provide NLM with digitized data

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MHA Systems and NLMs History of Medicine
Division

• Specific Steps
• MHA Systems to scan and mark-up books and
  manuscript materials from the History of Medicine
  Division
• NLM to assist MHA in assessing technical
  needsskills, technology, work flow, quality
  control, and with business management training
• NLM to secure appropriate training and provide
  oversight
• Move to production after training period

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MHA Systems and NLMs History of Medicine
Division

• What was scanned?
• Wyndham Miless History of the National Library
  of Medicine
• Minutes of the Librarys Board of Regents
  meetings
• NLM Annual Reports
• NLM Technical Bulletins
• What was produced?
• PDF files and XML mark-up for web display

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MHA Systems and NLMs History of Medicine
Division

• Who were involved from NLM?
• Fred WoodOffice of Health Information Programs
  Development, NLM
• John Rees, Curator of Manuscripts, Images and
  Archives Section, History of Medicine Division
• Paul Theerman, Head, Images and Archives Section,
  History of Medicine Division
• Susan Schreibman, Assistant Dean and Head of
  Digital Collections, University of Maryland
  Librariestechnical training and assistance

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MHA Systems and NLMs History of Medicine
Division

• Who were involved from MHA?
• Rosie Johnson, and then Richard MayerMHA Systems
  CEO
• Chris Rabbithead and then Jonathan
  Berryhillproject directors
• Joan ZavalnyMHA Systems
• Jerry StaiMinot State University School of
  Business, advisor
• Many scanners and coders from MHA Nation

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MHA Systems and NLMs History of Medicine
Division

• Timeline
• Materials sent fall 2004
• Site visit in December 2004Theerman, Rabbithead,
  Zavalny, Johnson, and Rees (Wood photographing)

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MHA Systems and NLMs History of Medicine
Division

• Timeline
• Training in April 2005Rees and Schreibman,
  Theerman and Wood as assistants/observers

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MHA Systems and NLMs History of Medicine
Division

• Successful Trainees

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MHA Systems and NLMs History of Medicine
Division

• Timeline
• Into production in the second half of 2005
• Materials added to NLMs website, NLM Archives,
  in 2005-2006
• http//www.nlm.nih.gov/hmd/manuscripts/nlmarchives
  /index.html
• Total amounts
• A 525-page book
• 40 sets of Regents Minutes
• 52 Annual Reports
• 271 issues of Technical Bulletins

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MHA Systems and NLMs History of Medicine
Division

• New Projects
• New project in 2006 scanning printed materials
  to provide an on-line guide to a very large NLM
  collection on the Food and Drug Administration
  (FDA)
• 60 volumes of materials to be scanned prior to
  OCR and data extraction
• Project will go into 2007

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MHA Systems and NLMs History of Medicine
Division

• Experiencesome hesitations
• Staff turnover was high.
• Tension between a turn-key operation and one with
  stronger input from MHA.
• Difficulties in working half a continent away.

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MHA Systems and NLMs History of Medicine
Division

• Experiencesome positives
• Technology not a barrier, and was a help.
• Great pleasure in the training and in seeing the
  project take off.
• It works!

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MHA Systems and NLMs History of Medicine
Division

• Thanks to
• Elliot Siegel and Fred Wood, Office of Health
  Information Programs Development
• John Rees, Curator of Manuscripts
• Susan Schreibman, technical consultant
• Jonathan Berryhill, Rosie Johnson, Richard Mayer,
  Chris Rabbithead, Joan Zavalny, and numerous
  scanners and coders, MHA Systems
• Jerry Stai, business consultant

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Developing an NLM Exhibition about Native
American Concepts of Health and Disease

• A discussion about
• cultural competency
• by Patricia Tuohy, Head
• NLM Exhibition Program

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Sources

• Center for Effective Collaboration and Practice
  cecp.air.org
• National Center for Cultural Competence
  Georgetown University Child Development Center
  gucchd.georgetown.edu/nccc/
• Terry Cross, et al. Towards a Culturally
  Competent System of Care. 1989
• Michael Baxandall, Exhibiting Intention Some
  preconditions of the Visual Display of Culturally
  Purposeful Objects, Exhibiting Cultures The
  Poetics and Politics of Museum Display. I. Karp
  and S. Lavine, eds.

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What exhibition development has in common with
competent health promotion

• Culturally competent approaches to health
  promotion respects the cultural values, beliefs,
  and practices of the intended audience
• So, too, does good exhibition development

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Working definitions

• Cultural knowledge familiarization with selected
  cultural characteristics, history, values, belief
  systems, and behaviors of the members of another
  ethnic group.
• Cultural awareness developing sensitivity and
  understanding of another ethnic group. This
  usually involves internal changes in terms of
  attitudes and values. Awareness and sensitivity
  also refer to the qualities of openness and
  flexibility that people develop in relations to
  others.
• Cultural sensitivity knowing that cultural
  differences as well as similarities exist without
  assigning values to those cultural differences.

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What is cultural competency

• Cultural competency is defined as a set of
  congruent behaviors, attitudes, and policies that
  come together in a system, agency, or among
  professionals and enables that system, agency, or
  those professionals to work effectively in
  cross-cultural situations.
• Cultural competency emphasizes the idea of
  effectively operating in different cultural
  contexts.

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• Health promotion
• medical experts
• health communicators
• audiences

• Making exhibitions
• makers of objects
• exhibitors or exhibition developers
• viewers of made objects or exhibition visitors

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Questions for you. . .

• How do you adapt and respond to different
  cultural beliefs and practices when providing
  health information?
• How do you and your organization or institution
  practice cultural competency?

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NLM contacts for further information

• Fred Wood, OHIPD, ph301-402-9278,
  fredwood_at_mail.nih.gov
• Gale Dutcher, SIS, ph301-496-5082,
  dutcherg_at_mail.nlm.nih.gov
• Angela Ruffin, NNO, ph301-496-4777,
  ruffina_at_mail.nlm.nih.gov
• Paul Theerman, HMD, ph301-594-0975,
  theermp_at_mail.nlm.nih.gov
• Patricia Tuohy, HMD, ph301-435-5240,
  patricia_tuohy_at_nlm.nih.gov